437 Cases Of Idiopathic IgA Nephropathy: Analysis Of The Clinical Characteristics And Histopathological Lesions

【Background and Objective】IgA nephropathy is the most common form of glomerulonephritis in the world,and is also the main cause of end stage renal disease. Now it is considered to be a clinicopathological syndrome with the same immune-histological feature,characterized by deposits of IgA with or without other immune-complex in the mesangium of the glomerulus.The disease has lots of various clinical presentations and histological lesions.A renal biopsy is required for an accurate disgnosis of IgA nephropathy and the degree of the histological lesions plays an important role on prognosis and treatment of the disease.Anyway,many hospitals in our country are not able to do renal biopsies until now and little patients accept a repeat renal biopsy during the follow-up time.So clarifying the relationship between clinical presentations and renal pathological lesions of IgAN may give us important references in clincal practice.In this research we anlysis the clinical and pathological characteristics of 437 cases digonised IgA nephropathy these years in our hospital, aim to investigate the relationships with each other,find out the clinical risk factors associated with the renal pathologic lesions and to predict the degree of the active and chronic histological lesions with the clinical presentation.【Subjects and methods】437 cases with IgA nephropathy is involved in our research.The clinical and pathological data at the time of renal biopsy were analyzed. We described the clinical characteristics and common pathological lesions in IgA nephropathy,assessed whether clinical presentation(24-hour proteinuria,uria red blood cell,arterial hypertension,renal function,age and gendar) correlated with the pathological lesions(the indices of masangial proliferation,glomerular sclerosis, crescents,tubelar atrophy,interstitial infiltration and fibrosis,especially the indices of the chronic pathological lesions) using the software SPSS 16.0.【Results】(1) IgAN account for 41.46%in the patients with primary glomerular disease,the ratio of male to female was 1.06:1,the apparen peak incidence age was 20-40 years old(60.7%),the average incidence age was 34.33±12.38years old(13-76 years old),the apparent age of male and female has no difference(p＞0.05). (2) 27.7%of the patients was found out the disease through a routine health examination without any symptoms.The incidence of gross hematuria was 29.8%, more common in younger patients.The incidence of other symptoms such as edema, lumbago was 28.6%,24.0%.Proteinuria with hematuria is the most common presentation,the incidence of it is 82.4%,respectively the incidence of proteinura without hematuria or isolated hematuria without proteinura was 10.8%and 6.7%.31 cases(7.1%) performed as nephrotic syndrome.The percentage of CKDⅠ-Ⅴstage was 48.7%,27.6%,16.3%,5.1%and 2.3%.(3) The incidence of arterial hypertention is 45.7%.Respectively,the incidence of high urine-acid hemaria,high triglycerideria and high cholesteria was 30.2%, 40.0%and 17.4%.The incidence of aterial hypertention and high triglycerideria was increased by aging.And high urine-acid hemaria and high triglycerideria were more common in male than in female.(4) Pathological lesions such as masangial proliferation,glomerular sclerosis, cresents formation,tubelointerstitial lesions and renal vascular injury was common in IgA nephropathy,the incidence of them was respectively 98.2%,69.1%,33.6%, 89.5%and 35.2%.The percentage of patients with LeeⅠ,LeeⅡ,LeeⅢ,LeeⅣ,LeeⅤis 7.78%,33.9%,33.9%,19.9%,,4.6%。(5) Patients with advanced chronic pathological lesions was also accompanied with the severe active lesions and clinical presentations in which the percentage of patients with proteinuria＞1.0g/d,decreased renal function and hypertention was increased.(6) The chronic lesions and active lesions such as masangial proliferatio and interstitial infiltration were more severe in the patients with＞lg/d proteinuria.When the proteinuria was more than 2.5g/d,the incidence and the degree of cellular cresent would be increased.In the patients with gross hematuria in one month before renal biopsy or with high level of urine red blood cells at the time of renal biopsy,we could see more cellular cresent formation.As the renal function decreasing,the chronic lesions were advanced,and the cellular cresent became more common to see.And the chronic lesions was also advanced accompany with the arterial pressure elevated.The chronic lesions was more severe in male patients and older patients.(7) The high level of blood pressure,the decrease of renal function and proteinuria more than l.0g/d are independent predictors of the advanced pathological lesions.On the other hand,the high level of urine red blood cells and the proteinuria more than 2.5g/d are independent predictors of cellular cresent formation.(8) Patients with isolated hemeturia is characterized by mild clinico-pathological presentation.Patients with nephrotic syndrome have severe active lesions but relatively mild chronic lesions,61.3%of the cases was in lowest chronic level, however 41.9%cases have the cellular cresent formation.【Conclusions】IgAN is the most common glomerulonephritis in China,and is account for 41.5%in primary glomerular disease.The ratio of male to female is 1.06, the peak incidence age is 20-40 years old,27.7%of the patients have no symptoms at the onset of the disease,29.8%of the patients may have gross hameturia.There are 7.1%of the patients presented nephrotic syndrome and 51.3%of the patients with decreased renal function in our data.Patients with advanced chronic lesions were in the more severe state of illness.Logistic Multivariete analysis shows he high level of blood pressure,the decrease of renal function and proteinuria more than 1.0g/d are independent predictors of the advanced pathological lesions.It also shows the high level of urine red blood cells and the proteinuria more than 2.5g/d are independent predictors of cellular cresent formation.